MSCT在评估双向格林手术治疗先天性心脏病的临床价值

目的探讨多层螺旋CT(MSCT)在先天性心脏病患儿行双向格林手术中的临床价值。方法回顾性分析经双向格林手术证实30例先天性心脏病患儿MSCT影像学资料,以手术结果为标准,超声心动图为对照,分析MSCT对术前先天性心脏病诊断符合率及术后疗效评价价值。结果手术证实单心室17例,肺动脉闭锁5例,三尖瓣闭锁4例,右室双出口各4例。MSCT术前诊断先天性心脏病符合率与超声心动图比较差异无统计学意义(P0.05)。术后MSCT复查显示吻合口通畅,同时MSCT显示胸腔积液3例,咯血1例,而超声心动图仅显示胸腔积液1例;MSCT显示腔静脉双侧均扩张10例,肺动脉双侧扩张9例;右侧上腔静脉管径明显比肺动脉大21例;上腔静脉于肺动脉正上方吻合24例。结论双向格林术前MSCT诊断先天性心脏病符合率高,对手术部位、血管吻合位置、管径、吻合口通畅与否、术后并发症等情况能清晰显示,在双向格林术后疗效评估上有重要作用。

Clinical Value of MSCT in Evaluating Bidirectional Glenn Shunt in the Treatment of Congenital Heart Disease

Objective To investigate the clinical value of multi-slice spiral CT (MSCT) in bidirectional Glenn shunt for patients with congenital heart disease. Methods The MSCT imaging data of 30 children with congenital heart disease confirmed by bidirectional Glenn shunt were retrospectively analyzed. The surgical results were taken as standard and the echocardiogram was taken as control to analyze the coincidence rate of MSCT in the diagnosis of congenital heart disease and to evaluate the curative effect after surgery. Results Surgery confirmed that there were 17 cases with single ventricle, 5 cases with pulmonary artery atresia, 4 cases with tricuspid atresia and 4 cases with double outlet right ventricle. There was no significant difference of coincidence rate in the diagnosis of congenital heart disease between MSCT and echocardiogram (P>0.05). After surgery, MSCT review showed that the anastomosis was unobstructed. Meanwhile, MSCT showed that there were 3 cases with pleural effusion and 1 case with hemoptysis while echocardiogram showed only 1 cases with pleural effusion; MSCT showed that there were 10 cases with bilateral dilatation of the vena cava, 9 cases with bilateral dilatation of the pulmonary arteries, 21 cases with right superior vena cava diameter significantly larger than that of the pulmonary arteries, and 24 cases with superior vena cava anastomotic right above pulmonary arteries. Conclusion The coincidence of MSCT in the diagnosis of congenital heart disease before bidirectional Glenn shunt is high. It can clearly display the surgical site, vascular anastomosis location, diameter, whether the anastomosis was unobstructed or not and postoperative complications. It plays an important role in evaluating the curative effect after bidirectional Glenn shunt.